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ADDRESS OR LOCATION: <br /> OWNERNAME: <br /> DATE <br /> APN: - - - -__ APPLICATION#: - <br /> SOIL TYPE - <br /> OE P1 H iG FIBS i WATER(—�_Ft <br /> REMARKS: <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES) <br /> _ PERCOLATION TEST SKETCH 1-� ION —' <br /> - PERCOLATION TEST SKETCH <br /> JR— H <br /> 1 ' <br /> 2-INDIA.PVC PIPET - .__i.._: -- <br /> 4-IN DIA.SOU,BORING 1 I 1 i '-IN DIA.PVC PIPL' <br /> 4-IN DIA.SOT,BORINC, <br /> REFU.LH_1 7'7`) <br /> — f — — <br /> REPLL.L FiEIGFfI <br /> ! I i <br /> SOIL PROFILE IF REQUIRED <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type_ Depth Soil Type <br /> Test Hole#1 Test Hole#2 <br /> r Parcel: Diameter n Depth: Parcel: Diameter in Depth: <br /> T 141E RLAOINC WAT EF Dfc:F' R1-i RE:i;._[o <br /> 1z <br /> fS h <br /> .5 1 SI <br /> t .( • y. T � <br /> "ll <br /> PERCOLATION RATE: ___ __�_ min/in PERCOLATION RATE:_ ( _ _ <br /> minlin <br /> RECOMMENDED SEPTIC AREA:______________ RECOMMENDED SEPTIC AREA: _ <br /> TEST PERFORMED BY: Phone: _ 1Date --- <br /> TEST CERTIFIED BY: _ _- Phone: -_ Date <br /> OBSERVED BY(REHS) _— Phone_____________ Date <br /> EHD 42-03REVIV2109 I'LR�'.IL51 PAI LIl <br /> Aoft <br /> Naseem Ahmed, Environmental Health Specialist <br />